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  • Larry McEvoy

The Syndemics of Health


Understatement: the pandemic brought the value of health into sharp relief.

The value of health itself—so often assumed—became tangibly essential when all of us were vulnerable, when there wasn’t a pill, when we couldn’t get toilet paper or food or an appointment to the dentist. It wasn’t healthy to get sick, but it also wasn’t healthy to be isolated, to be out of schools, ballgames, churches, and parks. It definitely wasn’t healthy to live angry and scream at each other.

We used to think wealth was the precursor to health, and for a while and to an extent, that was true. As we built a society bent on wealth, more wealth meant more jobs, longer life spans, and greater access to housing, nutrition and medicine (if you had access to wealth). As time has gone on, we now have to admit that at a time when the world creates more financial wealth than ever before, we are spawning an unstoppable stream of unhealth.

That’s quite an assertion, and it’s worth researching in depth if you’re interested. But the water pipes in Flint, the medical costs of dirty air, the skyrocketing of overdoses seeded by greed, the unstoppable upward strain of health care costs on the US economy, and the rates of obesity in children all point the same direction. So does the cost, in real dollars, of the pandemic and its associated chaos of broken supply chains, economic dislocation particularly for those without a cushion, lost school days, and explosions in mental health needs, domestic violence, violent crime, and overdoses.

It’s easy to see health/unhealth as personal, because it is. At the individual level, blood pressure and cholesterol are health, sure, but there’s so much more. Health is bodily, but it’s also neural, emotional, spiritual, nutritional, cognitive. It’s how we relate, how and what we eat, how we move, how we sleep, how we relate to ourselves and others, how we are heard, how we are shunned.

We have a lot of research and good common sense about what creates healthy people: lack of poverty, healthy relating patterns with ourselves and others, good nutrition, good sleep, good exercise, exposure to the outdoors and to stable and supportive social networks, avoiding the bad habits of drugs, tobacco, alcohol, bad eating, and risky behavior. It shouldn’t surprise us that we have a prolific personal health industry.

But while personal health–in knowledge and pursuit—blossoms for an emphatic and fortunate few, we can’t help but face a more foundational truth. Health arises out of social and environmental conditions, and we can’t control those alone, and we can’t escape them alone, even if we’re very rich, no matter how hard we try.

People who are overweight do eat—as individuals–different kinds of food, in different amounts, and spend more time being sedentary than would be good for them. They also live in a world where the wrong kind of food is cheaper to buy and easier to get, in a built environment that makes it easier to sit—escalator, elevator, plane, train, car, couch, chair—than to move. They also live in networks of people we call communities, and we have the data to show that people think, act, and interact (by probability and reality, not by jurisdictional legal freedoms) similarly to the people around them, and that makes them either healthier or unhealthier.

True health, for individuals and communities, includes but manifests and arises beyond the individual locus—the data show that it’s unbelievably contextual. Healthy water-land-air, healthy neighborhoods, healthy communities, schools, relationships, healthy food-energy-transportation, healthy building materials. Collective health supports healthy individuals who in turn support healthy communities, small and large. Healthy people can start businesses, drive innovation, weather illnesses and stresses; unhealthy ones can’t, at least at the level of odds. Health drives wealth and health, small to large and back again. It’s in our bodies, our homes, our neighborhoods, schools, companies, and politics.

Health, if you do the digging (and as we’re still discovering) is the ultimate return and source.

The pandemic taught us a lot of new things, and one of them was a new word: “syndemic.” A syndemic is an epidemic that runs with another epidemic. In medicine, where you find HIV, you find tuberculosis. Where covid was particularly lethal, we found obesity and other risk factors (though we were remarkably uncomfortable discussing the relationship between being overweight and getting sick from COVID). As Covid flourished, we found syndemics of domestic violence, opioid overdoses, and misinformation. Syndemics don’t have to be mutually causal to impact health—they just have to be mutually reinforcing.

Watching the syndemics of unhealth during the pandemic made me think about what the syndemics of health would be. What things would run together as a platform that would inevitably blossom into an unstoppable cloud of health. Could we fashion a pandemic of vitality now and for the future from what we have?

I’m proposing that if we were to prioritize health as both source capital and return on investment for individuals and populations (read: companies, schools, neighborhoods, polities), it would have to run through energy, transportation, food, finance, education, politics, church, marketing, purchasing–everything. Health would have to go pandemic. And beneath all those uncountable topics and sectors, people and processes, there must be some foundational scaling elements—syndemics–that would necessarily run with a pandemic of health.

These, then, are my candidates for the syndemics of health.

Leadership

We see everywhere what happens without it—or when it’s incompetent, ego-focused, or narcissistic. Leadership—what we pay attention to and ignore, whether we have an ethic of stewardship and health or one of extraction and ego, whether we have an inclusive approach or an imperial one, whether we value humility and community or arrogance and ego–counts and must sustain through the inevitable changing of roles and personalities. We can’t get to health without it. Imagine if leadership (everywhere, all the time) were inseparable from a focus on health of all stakeholders and a healthy approach to meeting that focus.

Innovation

We can’t get there by continuing the way we are—that didn’t work for the birth of aviation, computers, quantum physics, or the wheel. Innovation–the radical reforming, redesigning, and evolving of how we organize almost our entire civilization—will be required everywhere. Innovation, coupled with the wide diffusion (an innovation in itself) of what we already know, is an essential syndemic of a pandemic of health.

Community

Now that we have such powerful science that individuals influence community and community influences individuals (who knew?), “community” as that amalgam of place, purpose, and people that define “us” becomes a cornerstone infectious phenomenon that needs to pop up everywhere. Wherever any of us are, we want it to be healthy. No one wants an unhealthy home, neighborhood, job, school, or town. It’s the best place and way for us to work from what we all know and appreciate to what we all need. It’s the incubator of individual well-being and motivation mixing with collective will and support.

I understand this post will raise all sorts of questions: “Where’s the data?” “How is this practical?” “Where do I start?” “What about the economics?”Who decides?” All fair. Call me crazy, but I’m a doctor. I want health for everybody, and it’s way beyond my little black bag and sacred priestly knowledge muttered in polysyllabic latinate incantations.

Let’s have that discussion: how would you create “health everywhere,” for everybody, now and in the future? I’ll be looking to unleash my favorite three epidemics: leadership, innovation, and community.

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